建置肝癌病患導向之治療方式選擇評估模式

Building A Patient Oriented Treatment Selection Evaluation Model for Liver Cancer

陳正美(CHENG MEI CHEN)

指導教授 ： 徐建業

臺北醫學大學/醫學科技學院/醫學資訊研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00092

摘要

目前肝癌治療方式的建議，多著重於臨床的生理症狀，並未考量病患做選擇時生、心理社會層面的問題。本研究目的是幫助肝癌病患，了解選擇治療方式的影響因素；並探討臨床建議與肝癌病患對於治療方式選擇的不同。使用深度訪談與文獻查證，分析影響肝癌病患選擇治療方式的因素，結合本研究醫療團隊，參考美國用於選擇肝癌治療方式的 BCLC (Barcelona Clinic Liver Cancer) 分期建議，設計成問卷；並使用多屬性效用理論MAUT (Multi-Attribute Utility Theory)，建立選擇治療方式的決策模式，建置一評估系統；在不介入臨床作業流程下，進行53位肝癌病患及家屬的訪談。研究結果顯示，(1).臨床建議與肝癌病患對於治療方式的選擇不同。(2).肝癌末期病患，仍選擇積極的治療。(3).肝癌病患在選擇治療方式時，認為最重要的考量是治癒率、存活率與自我照顧能力。本研究結果協助肝癌病患，除了聽取醫師的建議外，可採用多種影響因素，以評估治療方式；在醫療照護人員方面，對病患內在的心理歷程亦可以有較多的瞭解，做為醫療照護的參考。

關鍵字

肝癌 ； 治療方式 ； BCLC ； 多屬性效用理論

並列摘要

Current liver cancer treatment recommendations focus on clinical physiological symptoms, and less on the problems in physical, psychological and sociological concerns of the patients. The purpose of this study was to help liver cancer patients to understand factors of treatment selection and studied the difference between what physicians’ recommendations and patients’ choice of treatment. We used in-depth interviews and literature review to analyze the factors of liver cancer patients involved in the selection of treatment. To design the surveys, We combined these factors with the Barcelona Clinic Liver Cancer (BCLC) stage recommendations which are used to select liver cancer treatment in the U.S. We also used multi-attribute utility theory (MAUT) to establish a decision model and build a evaluation system. Without interfering the clinical processes, we interview 53 liver cancer patients and families.The results shown: (1) There is a difference between physicians’ recommendations and the choice of treatment available to liver cancer patients; (2) Liver cancer Patients with terminal stage, will still choose actiive treatment; (3) The most important concerns of liver cancer patients’ choice of treatment are cure rate, survival rate and self-care ability. This study assist liver cancer patients to evaluate treatment using multiple factors rather than following only physicians’ recommendations, For health care personnel, we expect to provide an alternative direction, so that the underlying psychological processes of patients are taken into consideration.

並列關鍵字

Liver Cancer ； Treatment ； BCLC ； Multi-Attribute Utility Theory

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